Brachytherapy OR Prostatectomy

John the print
Massive thanks for your post

I'm in the same mind actually , for all the reasons you said

The thing though that has changed my mind to the clarity of decision is the March 2018 survey of 2000 Gleason 9/10 patients over 5 years 2013-18 where mixed Brachytherapy v Prostatectomy had a 3% mortality rate compared to 13% removal and 12% rate on radiation only

It seems to me , for my level of cancer and T level , that given the lower mortality risk and lesser side effects I've got to go the brachytherapy way

As you say time will tell if it's a right decision and it's one we all have to make on our own circumstances and diagnosis and can't compare others

Appreciate you sharing your thought process re decision making and also your feelings now

Wish you all the best for continuing good health
J

Hi Bollinge
Great you've taken a wider view of options and taken other treatment views (as I have being a newbie as diagnosed 6 months ago) from people on here who have been there

This thread and ALL the conversations and personal insight has been superb and massively useful . Thankyou to everyone who has posted

I've made my 100% decision to take on the theee way HT/Brachytherapy/ Radiotherapy as my treatment rather than a Prostatectomy operation or Proton therapy ( in Czech and investigated throughly )

It won't be right for everyone but on my T1c Gleason 9 diagnosis it's my decision based on:

1. Proton therapy
Even though their Wild West uber marketing brochure says they have a 99% success rate of cancer not returning in 5 years , for high grade cancer they say their rate falls to 79% which is no better than traditional routes . Oh and you pay £34,400 for the same potential result on stats

2. The results of the biggest survey measuring success rates of operation v brachy look strong in favour of brachy for Gleason 9-10 patients
In lack of ANY other comparative stats from anyone else this has made my mind
It's research by professionals and has my GPs view that it's 'clarity at last as best way to go' and even my surgeons view that this will be a 'gamechanger'

It may or may not mean anything about the future as it's only history , but in a role of helping others be informed to use as part of their decision making of prostatechtomy v brachytherapy , I've set out the findings below

INVESTIGATION
Published 06/03/18
By
A.Kishan MD / R.Cook MSPH / J.Ciezki MD
Los Angeles

QUESTION
Is there a difference in prostate cancer specific mortality and distant mestastasis associated with
1. Radical Prostatectomy (RP)
2. External beam Radiotherapy (EBRT)
3. EBRT with Hormone Theapy & Brachytherapy (EBRT+RT)

IMPORTANCE
The optimal treatment for Gleason score 9-10 is unknown

PARTICIIANTS
1809 patients treated between 2000 and 2013 in 12 cancer centres in USA (11) and Norway(1)

MEASURES
Primary outcome measure - PCancer specific mortality
Secondary outcome measure - distant metastasis survival

RESULTS

MORTALITY RATES
Adjusted Prostate Cancer specific mortality rates over time

Treatment. Mortality rate over 5yrs. Over 7.5yrs

RP. 12%. 17%
EBRT. 13%. 18%
EBRT+BT. 3%. 10%

INCIDENCE RATES OF DISTANT MESTASTASIS
Adjusted rates over 5years
RP. 24%
EBRT. 24%
EBRT + BT. 8%

CONCLUSIONS
Among patients with Gleason score 9-10 prostate cancer , treatment with EBRT+BT with hormone treatment therapy was associated with SIGNIFICANTLY BETTER prostate cancer-specific mortality and lower rates of distant metastasis when compared with EBRT alone or Radical Prostatectomy


As I say I'm not posting this to justify my decision or indeed belittle other treatments , it's just that it's NEW information and study results and may help others in making a massive decision on which there is not much comparison out there

My decision is based on
1. My cancer type and scoring
2. That the comparison study gives better chance of long life
3. That the comparison study gives less chance of returning
4. That EBRP+BT has less side effects

(As I'm 51 , being given a guarantee of impotency and incontinence on top of the other above possibly negative aspects of RP was a secondary benefit )

Many have told me that Brachytherapy has more chance of cancer returning that if the prostate is cut out

This study says that's not the case , in fact it's THREE times as much with Prostatectomy on Gleason 9-10 patients

If these results were used /treatments were horses in a race:

Brachytherapy has a 12.5/1 chance of cancer returning in 5years and a 33/1 chance of death in 5years
VERSUS
Prostatectomy has a 4/1 chance of cancer returning in 5years and a 12.5/1 chance of death in 5years

I know on these stats which horse my hard earned would be on in this race .....

Good luck to every prostate cancer brother ( and sister ) on this thread and I'll keep it going as to hopefully help others get a wider view of CHOICES .

After all that's all it is , as every case is different to the next and we are the ones left to make the call and THERE IS NO WRONG DECISION , it's YOUR gut feel and advice received that will make your mind

Best wishes to everyone posting for good health , fun and love
Much appreciated
Johnny

'Gotta get busy living , rather than getting busy dying'
Red

Thxs Ann
Much appreciated for your kind wishes

I make multi million £ decisions every day and this has been my hardest by far

Hope your husband doing well
Best wishes
John